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中华医学超声杂志(电子版) ›› 2019, Vol. 16 ›› Issue (02) : 147 -153. doi: 10.3877/cma.j.issn.1672-6448.2019.02.013

所属专题: 文献

基础研究

剪切波弹性成像评价肝脏微波消融灶边界的实验研究
魏珊1, 田超2, 林小影2,(), 朱才义2, 林香桃3, 程秋华4, 张植兰1, 高燕玲5   
  1. 1. 570000 中南大学湘雅医学院附属海口医院超声医学科
    2. 518000 深圳,暨南大学附属宝安妇幼保健院超声科
    3. 570000 中南大学湘雅医学院附属海口医院病理科
    4. 570000 中南大学湘雅医学院附属海口医院肝胆外科
    5. 518000 深圳,暨南大学附属宝安妇幼保健院产科
  • 收稿日期:2018-09-04 出版日期:2019-02-01
  • 通信作者: 林小影
  • 基金资助:
    海南省自然科学基金(20168311)

Ultrasound shear wave elastography for evaluation of boundary of liver lesions ablated with microwave

Shan Wei1, Chao Tian2, Xiaoying Lin2,(), Caiyi Zhu2, Xiangtao Lin3, Qiuhua Cheng4, Zhilan Zhang1, Yanling Gao5   

  1. 1. Department of Ultrasound, Affiliated Haikou Hospital, Xiangya School of Medicine, Central South University, Haikou 570000, China
    2. Department of Ultrasound, Affiliated Shenzhen Bao′an Maternity & Child Health Hospital, Jinan University, Shenzhen 518000, China
    3. Department of Pathology, Affiliated Haikou Hospital, Xiangya School of Medicine, Central South University, Haikou 570000, China
    4. Department of Hepatobiliary Surgery, Affiliated Haikou Hospital, Xiangya School of Medicine, Central South University, Haikou 570000, China
    5. Department of Obstetrics, Affiliated Shenzhen Bao′an Maternity & Child Health Hospital, Jinan University, Shenzhen 518000, China
  • Received:2018-09-04 Published:2019-02-01
  • Corresponding author: Xiaoying Lin
  • About author:
    Corresponding author: Lin Xiaoying, Email:
引用本文:

魏珊, 田超, 林小影, 朱才义, 林香桃, 程秋华, 张植兰, 高燕玲. 剪切波弹性成像评价肝脏微波消融灶边界的实验研究[J/OL]. 中华医学超声杂志(电子版), 2019, 16(02): 147-153.

Shan Wei, Chao Tian, Xiaoying Lin, Caiyi Zhu, Xiangtao Lin, Qiuhua Cheng, Zhilan Zhang, Yanling Gao. Ultrasound shear wave elastography for evaluation of boundary of liver lesions ablated with microwave[J/OL]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2019, 16(02): 147-153.

目的

探讨超高速剪切波弹性成像(SWE)在定量评估肝脏微波消融边界中的可行性与准确性。

方法

取健康雄性5月龄五指山猪15只,行开腹直视下肝脏微波消融术,消融功率选定40 W,根据消融时间分设为15 s、30 s、60 s三组。消融后即刻采用SWE测量消融灶的弹性模量值。术后利用HE染色、烟酰胺腺嘌呤二核苷酸(NADH)黄递酶组织化学染色评估肝组织的损伤程度。

结果

本实验共进行有效消融156次,有效SWE测量740次,得到有效病理结果131个。消融灶弹性模量值呈阶梯式同心圆分布,从中心向外周可分为3个区域。同一消融时间下弹性模量值在周边正常组织区域、消融边界区域、消融中心区域阶梯式增高(P均<0.01)。消融功率40 W,消融时间15 s、30 s、60 s在周边正常组织区域和消融边界区域的弹性模量值差异无统计学意义(P均>0.05),但在消融中心区域,其弹性模量值随消融时间的缩短而呈阶梯式降低,[60 s:(97.16±14.58)kPa>30 s:(77.84±9.64)kPa>15 s:(38.92±3.12)kPa],差异有统计学意义(F=2 131.832,P<0.01)。不同消融时间的消融边界区域弹性模量值保持在22.68~23.56 kPa。

结论

微波消融灶消融边界区域弹性模量值范围相对固定,SWE有助于定量评估肝脏微波消融边界,其在超声消融的监测与评估方面具有较强的实用价值。

Objective

To explore the feasibility and accuracy of ultra-high speed shear wave elastography (SWE) in quantitative evaluation of the boundary of liver lesions ablated with microwave.

Methods

Fifteen healthy five-month-old Wuzhishan pigs weighing (15±0.5) kg underwent microwave ablation under an open laparotomy. The ablation power was selected at 40 W, and the ablation time was set at 15 s, 30 s, and 60 s. Immediately after ablation, SWE was used to measure the elastic modulus of the lesion. The degree of liver tissue damage was assessed by HE staining and nicotinamide adenine dinucleotide (NADH)-diaphorase histochemical staining.

Results

In the study, 156 effective ablation procedures were performed, 740 effective SWE measurements were performed, and 131 effective pathological results were obtained. The elastic modulus of the lesions was distributed in a regional stepped concentric circle, which can be divided into three regions from the center to the outer circumference. At the same ablation time, the elastic modulus value increased stepwise from the surrounding normal tissue region to the ablation boundary region and ablation center region (P<0.01). There was no significant difference in the elastic modulus between the normal tissue region and the ablation boundary region (P>0.05), regardless of the ablation time (15 s, 30 s, and 60 s); however, the elastic modulus values in the ablation region showed a significantly stepwise decrease with the decrease in the ablation time [60 s: (97.16±14.58) kPa, 30 s: (77.84±9.64) kPa, 15 s: (38.92±3.12) kPa; F=2131.832, P<0.01]. The elastic modulus values of the ablation boundary regions at different ablation time points were maintained at 22.68 to 23.56 kPa.

Conclusion

The range of elastic modulus in the boundary region of microwave ablated lesions is relatively fixed. SWE can help quantitatively evaluate the effective damage range and type of liver microwave ablation, and has practical value in monitoring and evaluation of microwave ablation.

图1 猪肝脏直视下微波消融术。图a为手术暴露五指山猪肝脏;图b为经肝脏表面行微波消融
表1 猪肝脏不同消融时间进行微波消融术的有效数据
图2 猪肝脏组织消融术后不同区域肉眼观。消融灶可分为4个区域,分别为针道区域(红色箭头所示);针道周边区域(紫色箭头所示);消融边界区域(蓝色箭头所示);周边正常区域(绿色箭头所示);其中针道区域与针道周边区域同为消融中心区域
图3 猪肝脏组织消融术后不同区域HE染色病理切片肉眼观。消融灶可分为4个区域,但区域界限相对模糊,分别为消融中心区域(橙色箭头所示);消融边界区域(蓝色箭头所示);周边正常组织区域(绿色箭头所示);其中消融中心区域可见针道区域
图4 猪肝脏组织消融灶的HE染色病理表现(×200)。图a为消融中心区域,主要表现为核固缩性凝固性坏死;图b为消融边界区域,即坏死周出血带;图c为周边正常组织区域
图5 猪肝脏组织消融灶NADH黄递酶组织化学染色病理切片肉眼观,图示红色区域为消融中心区域(橙色箭头所示),其内可见针道;淡黄色区域为消融边界区域(蓝色箭头所示);淡紫色区域为周边正常组织区域(绿色箭头所示)。图a为消融功率40 W、消融时间60 s消融灶病理切片;图b为消融功率40 W、消融时间30 s消融灶病理切片;图c为消融功率40 W、消融时间15 s消融灶病理切片,因消融时间短,消融中心区域未完全形成,故肉眼下只看到消融边界区域与周边正常组织区域
图6 猪肝脏组织消融灶NADH黄递酶组织化学染色病理表现。图a,d为消融中心区域,因为细胞组织完全坏死,表现为红色条索样组织[图a(×100),图d(×200)];图b,e为消融边界区域,因为坏死与半坏死共存,表现为红色条索样组织和少量蓝紫色颗粒样共存[图b(×100),图e(×200)];图c,f为周边正常组织区域,主要表现为蓝紫色颗粒样[图c(×100),图f(×200)]
图7 猪肝脏组织消融术后超高速剪切波弹性成像测量图。消融灶可分为3个区域,消融中心区域呈红色或黄色,消融边界区域呈青色,周边正常组织区域呈深蓝色。图a为消融功率40W、消融时间15 s消融灶弹性成像图;图b为消融功率40W、消融时间30 s消融灶弹性成像图;图c为消融功率40W、消融时间60 s消融灶弹性成像图
表2 猪肝脏不同消融时间不同消融区域的弹性模量值(kPa,±s
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